CIMH Webcast
Functional Family Therapy
Andrea A. Neeb



”What really is the difference between a
Relabel and a Reframe anyways??”
Let’ s talk Relational Functions
Behavior Change planning and
examples..”How do we address multiple risk
factors and still stay within sessions
timeframes??”
Introduction to Meaning Change Techniques
Engagement & Motivation Phase, FFT

1 – Relabel: Provides an alternative, more benign “label” for a specific
behavior, emotion, attribution.

2 – Theme hint – short comment about a possible alternative domain
(especially emotional / affective) involved in a negative behavior – one that
tends to arouse less blaming and negativity.

3 – Reframe: introduces less intense and possibly more benign motives or
“reasons” for the negative Behavior.

4 – Reframe +: suggests noble but misguided intent with respect to a family
member’s negative behavior.

5 – Behavioral Theme: identifies a specific sequence, usually of within-family
behaviors, with reframes and/or relabels of most or all of the specific
behavioral elements, in a way that suggests non-malevolent (and even
possibly “noble”) intent or “reasons” behind all family members’ behaviors.

6 – Relational Theme: creates/suggests possible misguided benign, even
noble, and sometimes “accidental” intentions behind longer term relational
patterns and/or interpersonal styles. Relational themes often are quite nonspecific with respect to recent behaviors. Often they capture years of
relational unhappiness, dysfunction, & negative attributions about self (e.g.,
as in depression) and others, with recent events being a window into them.
1 – Relabel: Provides an alternative, more benign
“label” for a specific behavior, emotion, attribution.
Mom: “I’ve had it with him … maybe he should
go to “DT” (detention) for a while.”
Therapist: - To youth: “Sounds like your Mom
feels she has run out of steam to deal with this.”
This relabel of Mom’s “feeling” (“I’ve had it with him”) as
representing “running out of steam” tends to come across
as less blaming and rejecting, and moves the focus off of
a consequence (DT) that we as FFT therapists do not want
to be our main focus or goal. In doing so it allows the
therapist to refocus on family relational processes.
2 – Theme Hint – short comment about a possible alternative
domain (especially emotional / affective) involved in a
negative behavior – one that tends to arouse less blaming
and negativity.
 E.g., In response to rapidly escalating parent-child outbursts:
“OK … please forgive me for jumping here and interrupting, but
there seems to be lots of feelings of loss going on in this
family.”
Note that this represents a “theme hint” because it is not “developed”
at all – it is merely an assertion which the therapist is focusing NOT
on the obvious anger, but is assertively jumping in to impact (actually
stop if possible) the outbursts, but s/he does so in a way that:
1 – doesn’t take sides
2 – doesn’t tell them overtly that their behavior is “wrong” or a
“problem to be fixed,”
3 – (hopefully) will change the focus away from the “content” of the anger
and instead move them to other thoughts, feelings, memories, etc. ..
4 – by “hinting” about a possible “cause” (i.e., loss) for all the anger …
even if the therapist isn’t aware (as we often aren’t in early sessions) of
any specific content / history involving “loss.”
Reframe: introduces less intense and possibly more benign
motives or “reasons” for the negative Behavior.
Reframe +: suggests noble but misguided intent with
respect to a family member’s negative behavior.
Reframes consist of three simple components:
1) Identify and make clear the negative aspects of a
problem behavior / pattern (the one you are going to
attempt to reframe);
2) offer a possible benign (Reframe) or perhaps even noble*
(Reframe+) but misguided intent or meaning for the
behavior;
3) based on the family members’ reactions (affirming or
disaffirming) you refine and elaborate the reframe …
or you apologize for “misunderstanding” and move on.
* “Noble” intent = to benefit another
Mother to Therapist: “This is the third time she has
run away … she’s just out of control”
Therapist: “And Mom … that is unbelievably disruptive to you and
the whole family (clearly acknowledges the disruptive impact),
and I’m sure someone along the line has suggested she is just
trying to develop and show her independence (relabel) … but I’m
wondering if there is something more. As misguided as it is, I
wonder if she might also be trying to send you a message that
‘Mom, I see how burdened you are, so I’m trying to grow up fast
so you don’t have to worry about parenting me as much.’ (the
possible “noble intent” part of the reframe). Now we all know
that this way of doing it won’t work, but I wonder if she has been
able to tell you how worried she has been about your horrible
stress level? It might even be easier for you both to argue about her
(daughter’s) behavior than for either of you to feel the desperation
that I’m sure sneaks up on you Mom.
What is the Difference Between a Reframe and a Relabel?
Relabel – to change the “tone,” description, or meaning of a behavior
or feeling – but not necessarily address the motivation behind the
negative behavior
 In response to an angry outburst: “With that anger I can see how
agitated you are.” Note that “agitation,” when the word is
introduced, seems less intense and perhaps even less “negative.”
Both anger and agitation represent “feelings,” but “agitation”
tends to take the focus off the negative behavioral aspect.
Reframe – to acknowledge the negativity of a behavior but offer a
possible alternative explanation or motivation for the behavior
 “That was a pretty angry outburst “X”, but I’m wondering if in
addition to expressing your anger you weren’t also protecting “Y”
(Reframe+) by letting her know how sensitive you are about that
subject so she can work on bringing it up differently? And “Y,”
my guess is that because his agitation (Relabel) was so intense you
couldn’t hear the reaching out part of what “X” said.



Themes (con’t)
Like reframes, themes do include the elements of
1 – acknowledging painful and even “bad” patterns
of behavior;
2 – suggesting possible “misguided but noble,” or at
least benign (e.g., based on misunderstanding, etc),
intentions ... or they may even be offered as
possibly “unintentional.”
3 – being open to family member cues that indicate
rejection, acceptance, or some other response
(confusion), and capturing any movement towards
less negativity and more hopeful reaction with
therapist attention and elaboration.
Major Types of Themes
5 – Behavioral (Sequence) Theme: identifies a specific
sequence, usually of within-family behaviors, and provides
reframes and/or relabels of most or all of the specific
behavioral elements, doing so in a way that suggests nonmalevolent intent or “reasons” behind all family members’
behaviors.
6 – Relational Theme: creates/suggests possible misguided
benign, even noble, and/or sometimes even “accidental”
intentions behind longer term relational patterns and/or
interpersonal styles. Relational themes often are quite nonspecific with respect to recent behaviors. Often they capture
years of relational unhappiness, dysfunction, and negative
attributions about self (e.g., as in depression) and others.
Recent behaviors merely represent a “window” into these
more basic (and usually sad!) relationship patterns.
Transitioning From E&M to Behavior Change &
Generalization
Overarching Philosophy :
Matching & Strength
Based Relational
Having Attained
Balanced Alliance
Decreased Negativity
& blame
Increased Family
bonding
Changed (Much more
Positive)
attributions
Positive Body
Language
Hopeful Attitude
Sense of
“Familyness”
And
Accomplished
R
E
L
A
T
I
O
N
A
L
A
S
S
E
S
S
M
E
N
T
Behavior Change
Planning &
Behavior Change
Generalization,
Multi-systemic
Linking
Within Family Relational Functions: “Attachment”
When X relates to Y, the relational pattern (behavioral sequences in
the relationship ) of X’s behavior is characterized by:
high
Autonomy:
independence
separating,
Low levels of
psychological
intensity
(Fear of
Enmeshment?)
1
2
Autonomy
Midpointing
3
4
Contact/
closeness
5
low
low
Contact: closeness, connection:
high
enmeshment, high levels of psychological intensity
(Fear of abandonment?)
The Second Relational Dimension:
Hierarchy
Hierarchy refers to the pattern, over time, of
relative influence based on power, position, and
resources (as opposed to Relational Connection”)
Parent 1- up
Parent
Symmetrical:
(Exchange =
Behaviors)
Parent 1- down
Ecosystem Influences
Community
School
Peer
Groups
Referral &
Ongoing Problem
Behaviors
Extended
Family
Intra Individual
(Diathesis)
Factors &
Processes
Family Relational Patterns
Patterns that are changed to modify
problem behaviors - decrease risk and
increase protective factors
FFT Behavior
Engagement &
Relational Functions
Change &
Motivation,
inferred motivational substrates that
Assessment serve to motivate and maintain stability Generalization
Focus
in family (and other) relational patterns
Focus
Review: FFT Steps in the process of change
FFT Direct Treatment Phases :
Behavior Change (BC)
Based on the “AIM Model” (Alexander, Barton, Waldron & Mas, 1983;
*Change the problem
and Pugh
related
behavior(s)
by using the
Alexander,
& Parsons,
1998)
therapist skills of Teaching, Modeling, Coaching, providing
Technical Aids, and giving Directives & Homework that helps
families improve their ability in: Parenting, Youth Compliance,
Communication, Problem solving, Conflict management,
Managing anxiety, “urges,” PTSD, etc.
BEHAVIOR CHANGE
* Develop individualized change plans that fit “match”) the family
(values, Relational
Functions, abilities) and which increase
MOTIVATION
resources and competence in adaptive positive behaviors
* Eliminate dysfunctional behaviors (drug abuse, delinquency,
violence, maladaptive expectations & beliefs, etc) by changing
the processes (intra-individual, family relational, multisystemic)
that support them;
Behavior Change Phase Steps
1
– Plan
2
– Review literature / techniques
available
3
– Fit Relational Functions
4
– Be clear and specific
5
– use available “technology”
Syndrome Specific “Modules”
During Behavior Change (BC)


By the time you reach Behavior Change (BC), the
“meaning?” of major behavioral problem syndromes (such
as drug abuse, stealing, fighting, truancy) has been
changed via the strength based & relational focus coupled
with reframes and themes. We need to have attained
reduction in negativity and blame, experienced changed
within-family attributions about each other and
themselves, and having the “family struggle” rather than
an “individual’s problem” represent the reason we are
changing behavior.
If you think you are ready for BC, but the family fails to see
the problem behaviors in a different light or context, then
… you are not ready for BC!
Problem Specific BC (2)
At the same time you should know quite a bit about problem
behaviors based on referral info, CSS intake information,
and the usual complaints and accusations – which for a
while occur despite your strength based relational focus,
reframing, etc.
This can be attained easily without having to focus
specifically on the details of problem behaviors such as
drug abuse during E&M
Then your first task in BC is to insure that you have thought
about all you know in relational terms (who is present
when the behaviors occur, who responds when the
behavior becomes known, etc).
Planning for Behavior Change Phase
 Assessment
at first is on family relational
patterns and behavioral deficits, as well as
strengths that can be augmented
 The
new patterns must “work” for everyone
and “fit” Relational Functions
 Before
the first BC session, have a flexible plan
with BC change targets which are informed by,
but not exclusively driven by, referral /
“presenting” problems.
Behavior Change Planning (2)
1 - Review everything you’ve learned about changing
behavior: “Learning theory” (reinforcement, extinction,
partial reinforcement, Classical Conditioning (Often the
basis of emotional responses) and Operant Conditioning
(overt behavior). Review classic texts on parenting,
negotiation & problem solving, modeling, cognitive
rehearsal, substance abuse interventions. Use them all, but
always remember to ..
2 – Fit all techniques and Behavior Change goals into the
relational framework (especially Relational Functions) you
already have developed

Using Learning Theory Principles to Increase
Appropriate Behaviors
Remember that relational functions are a very
powerful motivational component of most
important within-family behaviors. Thus positive
reinforcement (e.g., positive attention to increase a
behavior which provides an alternative way to meet
relational functions) can be more powerful than
focusing on the “bad” behaviors, but it also must
“match” the Relational Functions of all members.
Incorporate relational (e.g., time alone – or time
together --depending on the relational function) as well
as tangible reinforcers (snack, book, movie, money,
taking out garbage)
 Remember that everyone needs to be recognized and
“reinforced.”

Behavior Change Examples

1. Mother and adolescent daughter came into to treatment
as a result of daughter’s probation violation of curfew.
Daughter has been staying in a shelter due to major
conflict between herself and mother. Daughter and mother
have had physical altercations in the past. Daughter most
recently accused mother’s live in boyfriend of making
inappropriate sexual gestures towards her. Daughter
attends school and works at same resteraunt mother does.
Both cannot communicate without blaming each other and
verbal abuse. Relatedness is both mother and daughter are
autonomous. Hierarchy is symmetrical with neither having
influence.
2.
Mother refers son for a Youth at Risk Petition which
activates a family counseling referral. Son is 17 yrs old, has
GED, a job, and plays in a band, and smokes marijuana on
a regular basis, which is mother’s chief complaint. Mother
is a single parent, very actively involved in her religion, has
2 other children who are older, one who is her other son she
is extremely upset with because he is homosexual, the
other is her daughter who is very close to her. Mother is
fearful of son’s drug use and that he does not respect her.
She constantly questions, interferes, nags her son. Son lives
in garage of the home. Mother is highly connected to son,
son is autonomous. Son is one up.